[Role of carotid artery stenting in stroke prevention]

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Extracranial carotid atherosclerosis causing significant internal carotid artery stenosis is a major risk factor for ischemic cerebral stroke.
• Carotid revascularization is a key strategy for primary and secondary stroke prevention in affected patients.

Purpose of the Study:

• To review current European guidelines on carotid revascularization for stroke prevention.
• To discuss the indications for surgical versus endovascular approaches based on patient risk and stenosis severity.
• To highlight the evolving role of carotid stenting as a therapeutic option.

Main Methods:

• Analysis of European guidelines regarding carotid revascularization.
• Comparison of indications for carotid endarterectomy and carotid stenting.
• Evaluation of patient selection criteria based on stenosis degree, symptoms, and peri-procedural risk.

Main Results:

• Surgical revascularization is recommended for symptomatic patients with >50% stenosis and <6% peri-procedural risk.
• Endovascular revascularization (carotid stenting) is considered for symptomatic patients at high surgical risk.
• Guidelines suggest revascularization for >60% stenosis with stroke risk factors, <3% perioperative risk, and >5 years life expectancy.

Conclusions:

• Carotid revascularization is crucial for preventing ischemic stroke in internal carotid artery stenosis.
• Patient selection for carotid endarterectomy versus carotid stenting depends on surgical risk and anatomical factors.
• Carotid stenting is increasingly recognized as a viable therapeutic strategy due to technological advancements and operator experience.